With a Mandate for Change, a Longtime HIV/AIDS Leader Steps Up as Chief Officer for NYC's Massive Human Service Agency

This summer, the de Blasio administration tapped Daniel Tietz for the newly created position of Chief Special Services Officer at New York City's massive Human Resources Administration (HRA).

Tietz graduated nursing school just as the AIDS epidemic was emerging in 1982. Since that time, his work in public health, non-profit and government services and policy has cut across many of the interlocking challenges of HIV in the U.S. -- including mental health, health literacy, housing and homelessness, research, LGBT rights and most recently, aging issues.

Tasked with managing all that HRA's 14,000 staff members do to provide direct services to New Yorkers, Tietz now oversees a broad range of programs, including Adult Protective Services; the HIV/AIDS Services Administration; Domestic Violence; Shelters and Services; Disaster Assistance and Crisis Management and Customized Assistance Services for public assistance recipients.

The former executive director of the AIDS Community Research Initiative of America (ACRIA) spoke with TheBody.com about his new role as the city prepares to take on the charge of "bending the curve" of HIV to end the epidemic in New York state.

What are top items on your agenda, as far as HIV/AIDS, as you're making this transition?

Well, the most notable of these is the governor's announcement in late June with regard to an "End of AIDS" plan; I think it's referred to by the governor as bending the curve. That's good, and it's fairly descriptive.

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By 2020, the goal is to have not more than 700 new infections annually in New York state -- which is a number below epidemic levels.

In calendar 2012, New York will be, for the first time in about 20 years, below 3,000 new diagnoses. So that's an ambitious goal: below 700 by 2020, which is only like five years from now.

We mostly know what to do. A plan at this point is half-developed; an outline is there with the [New York] State Department of Health, the City Department of Health and Mental Hygiene -- advocates worked on it over the last year.

What comes next is a task force that will be named by the governor, which, we understand, will happen very soon. And some number of city officials will be on it. I don't know that I'll be one of them. But certainly, folks from here will be a part of that. So I think that's the big push.

Because if you think about who's left to get to an undetectable viral load, they have much in common. There's poverty; mental health and substance use challenges; unstable housing, or homeless. So it's addressing those issues that will get us there. And unless there's coordination of not-for-profit community providers with city and state making that happen, we're not going to get there.

And by the way, New York doesn't get to "an end of AIDS," down to below epidemic levels by 2020, without full cooperation from the city -- because 80% of New York's epidemic is in the five boroughs [of New York City].

The people who are gainfully employed, whose lives are reasonably well organized, who have got housing, who have got insurance -- whether that's public, like Medicaid, or otherwise -- those folks are mostly taking their meds. They're mostly showing up for it. It's the hard ones that are left. It's the folks who are going to need more than that. They're going to need intensive case management.

We've got great models out there. Now we have to scale those up. We have some of that happening right here in the city by providers we know well. We need to expand that. In terms of HIV and HRA -- all of our anti-poverty efforts here, the employment plan that we're working on now with the state; all of the mayor's initiatives with regard to both affordable housing and addressing inequality -- all run in this direction, too. If you think about this, they run together. So I think it's building on that and the governor's announcement. We're going to be committed about that.

One of the things you worked on during your time at ACRIA was pushing for deeper understanding and engagement on HIV and aging. What is the state of HIV and aging? What has been gained or achieved, and what's left to do? And is there some crossover of what's on your plate in this role?

A lot happened with that. And I'm really pleased about that, I have to say. I've expressed frustration with UNAIDS, and less with the [New York] State Department of Health AIDS Institute, which has been pretty thoughtful on this whole issue, recognizing that people on meds are going to live, and that means they're going to get old -- which is what we all wanted! The whole idea was that you wouldn't die. You wouldn't die young. I mean, you would die in the natural course of things, if you will.

If the worldwide goal is not less than 15 million on meds by 2015, did anybody think that they're all going to live now? And then what? Then what will their needs be? What will we have to do differently than you would for a 25-year-old, or a 35-year-old, with HIV?

So we're pleased to have gotten that on the agenda, and ever-increasing responsiveness from providers and people with HIV themselves who have the comorbidities, have needs that are, if you will, beyond their years. When you're a 58-year-old and you've got three comorbid conditions, and you're not yet eligible for Medicare, and you're not yet eligible for a host of senior services (which turn on chronological age), but you're not so disabled that you can get disability, what do you do?

A number of providers across the country, and beyond the U.S., are thinking it through: How should we reconfigure our services to actually meet this growing need that is, by the way, mostly good news? It's also true that about one in six new diagnoses are in people above age 50. And I'm careful to note diagnoses as opposed to new infections. We don't have as good data on new infections above age 50 -- at least not in this country.

So we're pleased to have gotten it on the agenda. And having just come back from Melbourne, from the International AIDS Conference, more than ever before this was on the big agenda. There was more talk about this. There were more sessions that were devoted to this topic, and thinking through what happens when you keep people alive, and how would their needs change.

So, shifting to our context here: there are 32,000 New Yorkers with clinical, symptomatic HIV (because, of course, that's the definition for HASA [the city's HIV/AIDS Service Administration], as it stands now). If we do our jobs right, they're all going to get old. It's very much thought of here. There's a lot of focus at HASA about what would we need to do differently to better meet that need. It's definitely on the agenda.

You're stepping into this gig as the "30% rent cap" has finally been put in place. So can you describe what that is, and what the landscape looks like now that things are changing?

New York is an expensive place to live. Housing here is tight and expensive. Essentially, the state budget that got passed in March included a 30% rent cap. For folks who are being served by HASA -- again, people who have mostly clinical, symptomatic HIV disease, or AIDS -- who meet public assistance eligibility requirements for enhanced rental assistance, will get their rent capped at 30% of their income. And the city and state, in a deal, will pay the difference.

That comes to some 7,000 of the 32,000 or so HASA recipients. So it's a big impact.

We have people who have been residing in supportive housing who arguably today don't need it, and don't want it, and are only there because they had no way to move out, because they didn't have enough income to rent an apartment. We have other folks who are living in emergency housing, often SROs [single room occupancy housing] that are not desirable, that are not good places for anyone, much less somebody with HIV. And they're living there for some of the same reasons. They would otherwise be just homeless.

So we're glad for it. We've just made retroactive payments to a chunk of folks, for the period of April to July, who were in the same apartment from April 1 to July 1, at the same rent.

In terms of going forward and actually getting some folks moved out, we have two priority populations. One is those folks in supportive housing who are ready, willing and able to go, who want to live on their own. And then a chunk of folks who are in emergency housing who also are ready, willing and able.

It's a tough housing market. But we're very committed to making this work.

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